Department of Orthopedics, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
Department of Orthopedics, Affiliated Fenyang Hospital of Shanxi Medical University, Fenyang, 032200, China.
J Orthop Surg Res. 2021 Nov 27;16(1):695. doi: 10.1186/s13018-021-02774-y.
No prognostic model for the survival of fragile hip fracture has been developed for Asians. The goal of this study was to develop a simple and practical prognostic model to predict survival within 1 year after fragile hip fracture in Asians.
A single-center retrospective cohort study was designed. Under a multivariable Cox proportional hazards regression model, we used the preoperative characteristics of patients to predict survival within 1 year after hip fracture. We built a full model and then used the least absolute shrinkage and selection operator (LASSO) method to further shrink the model coefficients and achieved variable screening. Finally, we obtained a LASSO model. The model performance was evaluated with Nagelkerke's R and the concordance (c) statistic. We assessed the internal validity with a bootstrapping procedure of 1 000 repetitions.
A total of 735 eligible patients were admitted to our department for hip fracture from January 2015 to December 2020, but 11 (1.5%) patients were lost to follow-up. Among the remaining patients, 68 (9.3%) died within 1 year after hip fracture. We identified 12 candidate predictors from the preoperative characteristics of the patients. The last model contained nine predictors: surgery, age, albumin, sex, serum creatinine, malignancy, hypertension, ability to live independently, and cardiovascular and cerebrovascular diseases. Among them, surgery, age, and albumin are effective predictors of survival. The discrimination c statistic of the model is 0.814 (95% confidence interval 0.762-0.865); the corrected value through internal validation is 0.795.
This prognostic model can accurately predict a 1-year survival rate for patients with fragile hip fractures. This information can help clinicians develop a reasonable and personalized treatment plan.
目前尚未针对亚洲人开发出用于预测脆弱性髋部骨折患者生存情况的预后模型。本研究旨在开发一种简单实用的预后模型，以预测亚洲脆弱性髋部骨折患者 1 年内的生存情况。
采用单中心回顾性队列研究设计。我们使用患者术前特征，通过多变量 Cox 比例风险回归模型来预测髋部骨折后 1 年内的生存情况。我们构建了一个全模型，然后使用最小绝对收缩和选择算子（LASSO）方法进一步收缩模型系数并进行变量筛选，最终得到 LASSO 模型。采用 Nagelkerke 的 R 平方和一致性（c）统计量评估模型性能。通过 1000 次重复的 bootstrap 程序评估内部有效性。
2015 年 1 月至 2020 年 12 月，共有 735 例符合条件的髋部骨折患者入住我院，但有 11 例（1.5%）患者失访。在其余患者中，有 68 例（9.3%）在髋部骨折后 1 年内死亡。我们从患者的术前特征中确定了 12 个候选预测指标。最终模型包含 9 个预测指标：手术、年龄、白蛋白、性别、血清肌酐、恶性肿瘤、高血压、独立生活能力以及心血管和脑血管疾病。其中，手术、年龄和白蛋白是生存的有效预测指标。该模型的判别 c 统计量为 0.814（95%置信区间 0.762-0.865）；内部验证校正值为 0.795。
该预后模型可准确预测脆弱性髋部骨折患者 1 年生存率。该信息有助于临床医生制定合理的个体化治疗计划。
